June 5, 2010

How We Are Living With HIV

Welcome to another day in my life. Today is Saturday and I hope your weekend is off to a safe and great start. One of the reasons I love weekend is I usually do not have conference calls or meetings and there are fewer (although still over 200) emails a day.

So I use the weekends to get caught up and hopefully get some rest when I am not making appearances out of town at events, conferences and fund raisers. Which leads to the topic for today which is how are we living with HIV?

Back in the early 80s when I asked how long I had to live, the answer was grim. I was told I would probably not live to see my 20th birthday which was only six weeks later.

Today, the future is far brighter for me and millions of others infected with the human immunodeficiency virus, or HIV the retrovirus that causes acquired immunodeficiency syndrome, or AIDS. Because of the development of truly transformative drugs by researchers in government, at universities and hospitals, and in the biotech and pharmaceutical industries, HIV positive people can now look forward to decades of life. Someone diagnosed today can expect to survive until age 70 or even beyond.

The Search for an AIDS Vaccine

The United Nations estimates that more than 33 million people globally including about 2 million children and 15 million women are currently infected with HIV. If untreated, HIV destroys the immune system, rendering the body vulnerable to life threatening infections and cancer.

More than two dozen drugs to suppress HIV infection are now available, usually used in combinations known as HAART (Highly Active Antiretroviral Therapy), or more commonly as AIDS cocktails. Because HIV mutates rapidly and because some people can not tolerate certain drugs, doctors sometimes need to switch patients to different combinations of drugs over time to keep their infections under control.

NIH supported much of the research to develop these drugs and is helping to determine the best way to use them in different populations. This information will be key in implementing the President's Emergency Plan for AIDS Relief and other programs that provide greater global access to HIV therapies. More than 4 million people in the developing world now get antiretroviral drugs thanks to this outreach.

A Team of Doctors Will See You Now

But much more remains to be done. Each year, about 2 million people worldwide die of AIDS. An additional 2.7 million 56,000 in the US become newly infected with HIV. Unless we stop these new infections, it will be extremely difficult, perhaps impossible, to provide appropriate therapy for all HIV positive people.

Prevention is the key to defeating this terrible disease. And that is where medical research's biggest challenges lie as we prepare to enter the fourth decade of the AIDS pandemic.

HIV can be transmitted by sex, sharing needles and syringes, and from mother to child at birth or through breast milk. HIV also can be spread by blood. However, since 1985, all donated blood in the U.S. is tested for HIV, making transmission through transfusion extremely unlikely.

A major obstacle to reducing HIV transmission is that many people one in five in the U.S. alone do not know they are infected and may inadvertently be spreading the virus. The US Centers for Disease Control and Prevention recommends that everyone between ages 13 and 64 be tested for HIV. The benefits of more frequent testing, perhaps every year, for high risk groups such as those who have unprotected sex with multiple partners or use injected drugs, are also being studied. Earlier detection would not only curb HIV transmission but might help those already infected, since there is evidence that patients who get early treatment tend to live longer than those treated later on.

Revealing the Body's Deepest Secrets

Another new preventive approach, pre-exposure prophylaxis, involves encouraging uninfected people who continue high risk activities to take antiviral drugs in advance. The idea is that the drugs might lower the odds of an HIV infection taking hold if the person were exposed.

No current drug or combination of drugs can currently cure HIV infection that is, totally eradicate the virus from an HIV positive person's body. Some researchers are pursuing that goal. Others are aiming for a functional cure, in which antiretroviral drugs would so lower levels of HIV that the patient's own immune system would keep the virus in check once drugs were discontinued.

Some rare individuals have a genetic variation that almost always protects them from HIV infection, even if they are repeatedly exposed to the virus. By studying their genetic makeup, researchers hope to design new therapies that confer the same resistance to those who did not win the genetic lottery. Other individuals have immune systems that control the virus exceptionally well after infection. Studying these elite controllers may help create an HIV vaccine.

An effective vaccine remains the ultimate goal in HIV prevention. After more than 20 years of research, there is finally a glimmer of hope. A large study in Thailand recently provided the first signs that a vaccine could actually prevent HIV infection, albeit in a relatively small percentage of those vaccinated. Much more research is needed to understand how this vaccine regimen works and how its efficacy might be increased.

Until an effective vaccine is available, the best defense against HIV is to avoid injection drug use and needle sharing and not engage in unprotected sex in a relationship in which there's any doubt about a partner's HIV status.

I encourage others, particularly young people, to take these preventive messages to heart. You can live a normal life and be happy if you are HIV positive. But it is better not to be infected at all.

Until we meet again; here's wishing you health, hope, happiness and just enough.